{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOUGLAS   W THORNTON","gend":0,"add":"1234 HAMPTON AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1963-10-14","age":"","mstatus":"","insh":"2023679*01","cliId":"","pno":"757\/218-7120","cno":"757\/218-7120","email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":119880,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/873-0345","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","B97.89","R05.","I50.22","I08.3","Z00.00","I34.0","I07.1","I35.1","I51.7","I42.8","I11.0","Z95.810","H40.1133","Z95.0","I50.9","Z87.891","I13.0","N18.2","R06.83","Z91.14","F14.21","E78.5","G47.30","G47.10","Z79.899","Z01.810"],"date":["2020-01-06","2020-01-06","2020-01-06","2021-07-12","2021-01-31","2021-01-05","2021-01-29","2021-01-29","2021-01-29","2021-01-31","2021-07-12","2021-07-12","2021-07-01","2021-07-07","2021-03-15","2020-01-06","2021-03-15","2021-02-22","2021-02-22","2020-06-04","2020-04-30","2020-11-05","2021-07-12","2020-06-04","2020-06-04","2021-03-15","2021-02-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69452014320","BENZONATATE","100MG","20","Select","Select",""],["","68645056259","IBUPROFEN","600MG","9","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","-30","Select","Select",""],["","50383023310","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","68645055554","LISINOPRIL","40MG","-90","Select","Select",""],["","68382009505","CARVEDILOL","25MG","180","Select","Select",""],["","00078077720","ENTRESTO","49-51MG","60","Select","Select",""],["","00310621030","FARXIGA","10MG","-30","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","-30","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","69238149101","BUMETANIDE","2MG","120","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","59528041605","MAGNEBIND","400","30","Select","Select",""],["","50111032701","HYDRALAZINE","25MG","270","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","9","Select","Select",""],["","69452014320","BENZONATATE ","100MG","20","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","2","Select","Select",""],["","50383023310","DORZOL\/TIMOL ","22.3-6.8","10","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","90","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","180","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","60","Select","Select",""],["","59528041605","MAGNEBIND ","400","30","Select","Select",""],["","69238149101","BUMETANIDE ","2MG","60","Select","Select",""],["","00310621030","FARXIGA ","10MG","-30","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","50111032701","HYDRALAZINE ","25MG","270","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","00143177101","ISOSORB ","10MG","90","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}